Models of Nursing and Its Benefits - Essay Example

MODELS OF NURSING 2007 Models of Nursing Nursing models are conceptual models which rely upon certain concepts and theories of nursing and "provide information about: definitions of nursing and nursing practice, principles that form the basis for practice, and goals and functions of nursing" (Wesley, 1995: 2). The evolution of modern nursing models can be traced to the emergence of nursing as an independent field of knowledge and profession in the middle of 19th century when Florence Nightingale differentiated nursing from medicine. Nightingale's model relies exclusively upon the idea that the nurse plays decisive role in shaping the nursing environment to promote the well being of patients (Nightingale, 1859). Numbers of important nurse theorists such as Clara Weeks-Shaw, Isabel Hampton Robb, Imogene King, Hester Frederick, Myra Levine, Hildegard Peplau, Bertha Harmer, and Virginia Henderson contributed to the emerging discipline by describing various nursing models throughout the late 19th - late 20th centuries (Wesley, 1995). Each model of nursing has two elements: a method to assess individual needs of the patient and a method to implement the adequate type of care. These elements are used to a document known as a 'care plan' that is employed to identify the essential characteristics of a patient's treatment by doctors, nurses or/and health professionals. The process of treatment is measured and the quality of a patient's care is evaluated with appropriate changes being done to the care plan (Polit, & Hungler, 1995). In the 19th century, nurses were predominantly viewed as mere executors of the doctor's prescribed care. Such limited perception of the nurse's function resulted in emergence of a set of biomedical models of nursing that continue to strongly affect the modern nursing practices (Snyder, 2001). The key characteristic of the biomedical model is excessive attention to pathophysiology and altered homeostasis which did not allow advocates of this approach to properly identify individual differences between the patients. Consequently, although the biomedical model was effective for traditional medical and physical care, it failed repeatedly in cases which went beyond traditional frameworks: the focus on the treatment of disease prevented the nurses and doctors from making appropriate account of sociocultural, psychological, religious, or economic differences between the patients (Hawkins, 1987). The development of constructivist, functionalist, and interpretive epistemologies over the second half of the last century led many to revise the traditional biomedical models. As a result, the social model of nursing and healthcare that emerged in the 20th century highlighted the social aspects of treatment and nursing. While the biomedical model basically viewed all patients suffering from the same illness or disease as the same population, the social model emphasized the individual difference in religious, cultural, ethnic background of the patients (Wesley, 1995). The holistic principles promoted by the social models perfectly complement for the drawbacks of the biomedical models. The modern models of nursing aim to find the most effective combination of the biomedical and social models. Dorothy Johnson's Behavioural System Model "focuses on a behavioural system (the patient), its subsystems, and its environment" (Polit, & Hungler, 1995: 102). Johnson views the patient's behaviours are the primary objects of nursing analysis claiming the human being has seven behavioural subsystems: attachment, dependency, ingestive, eliminative, sexual, aggressive, and achievement. Each of these subsystems arises from a drive related to a desired goal, a set of likely responses specific to the individual, a group of choices as to effective responses, and the observable outcomes known as behaviour (Johnson, 1990). Some claim that nursing diagnoses in the Behavioural System Model may deal with insufficiency, discrepancy, incompatibility, or dominance Another well-known model of nursing proposed by Imogene King relies upon the interactionist perspective and includes three types of dynamic, interacting systems: Personal systems - represented by individuals; Interpersonal systems - represented by such dyadic interactions as, for example, dialogue between the nurse and the patient; Social systems - represented by larger institutions such as families, nursing facilities, hospitals, or other medical institutions (King, 1981). This model focuses on client participation and mutual goal setting the combination of which provides an effective interactive framework for nursing practices. Levine's Conservation model of nursing pays particular attention to the ability to perceive patients as holistic beings and understand that the primary goal of nursing and treatment is to maintain the patient's wholeness (Levine, 1966). Henderson's Nature of Nursing model defines nursing from the functionalist perspective terms: "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible" (Tomey, & Alligood, 1998). Other known models are Neuman's Systems Model, Orem's Self-Care Framework, Rogers' Science of Unitary Human Beings, Roy's Adaptation Model, Ernestine Wiedenbach's Helping Art model, Leininger's Theory of Culture Care Diversity and Universality, Newman's Theory of Health as Expanding Consciousness, Parse's Theory of Human Becoming, Orlando's Theory of the Deliberative Nursing Process, Peplau's Theory of Interpersonal Relations, and Watson's Theory of Human Caring. Although the authors of each model identify a unique set of components, the latter fall into several major groups. Basically, a nursing model represents a system comprising five basic components: values, professional relationships, a patient care delivery model, a management approach, and compensation and rewards. Hoffart and Woods (1996) analysed five well-known nursing models described in the literature to identify the most commonly mentioned types of these components: The values most often used in the models in relation to the nurse are nurse autonomy, nurse accountability, professional development, and emphasis on high-quality care. Primary nursing and case management are most often used in the models in regard to professional relationships. Teamwork, collaboration, and consultation consistently are the most popular approaches to enhance professional relationships. Decentralizing decision making, expanding the scope and type of unit nurse manager responsibilities, and instituting structural changes to support professional practice were common activities in the management subsystem. Professional achievement and contribution toward organizational goals are most often mentioned criteria of the compensation and rewards subsystem (Hoffart, & Woods, 1996). Each model of nursing also has three sides: the nurse, the patient, and the environment. Ideally, these three sides must be fully considered and perfectly balanced in order to achieve excellence in nursing. However, the models' names demonstrate that such balance is a matter of the future: different models tend to overemphasize one or two of these sides and underestimate the importance of the rest. Thus, the Environmental Adaptation model of Nightingale gives strong consideration only to the environment while neglecting the other two. By contrast, the modern models, which rely upon the interpretivist and functionalist perspectives, pay overwhelming attention to the interaction of the nurse and patient, and often underrate the importance of environmental factors. The benefits provided by the nursing models are numerous. Firstly, the models of nursing provide a systematic problem-solving approach to the nursing process and properly organise the nursing practices. The models vary greatly between countries and institutions, but this benefit is common to all of them. Secondly, each of the existing models of nursing represents a contribution to the body of knowledge on nursing activities thus helping to further unveil the unique functions of the nurse. Therefore, it will not be an exaggeration to state that emergence of each new nursing model is a step toward further improvement of the quality of nursing (Chalmers, 1989). And finally, the nursing models help nurses and doctors achieve uniformity in their care of the patients. This improves the accuracy of assessment and evaluation and results in more benefits for the patient. References [1] Chalmers H. A. (1989). Theories and models of nursing and the nursing process. Recent Advancements in Nursing, 24, 32-46 [2] Johnson, D. E. (1990). The behavioral system model for nursing. In M. E. Parker (Ed.), Nursing theories in practice. New York: National League for Nursing, 23-32 [3] Hall, L. E. (1963, November). Center for nursing. Nursing Outlook, 11, 804-806 [4] Hawkins, Joellen W. The Historical Evolution of Theories and Conceptual Models for Nursing. 1987 [5] Hoffart N, Woods C. (1996, November-December) Elements of a nursing professional practice model. Journal of Professional Nursing, 12(6), 354-64 [6] King, I. M. (1981). A theory for nursing: Systems, concepts, process. New York: Wiley [7] Levine, M. E. (1966). Adaptation and assessment: A rationale for nursing intervention. American Journal of Nursing, 66, 2450-2453 [8] Nightingale, F. (1859). Notes on nursing: What it is, and what it is not. London: Harrison. [9] Polit, D. F., & Hungler, B. P. (1995). Nursing research: Principles and methods (5th ed). Philadelphia: J. B. Lippincott Company. [10] Snyder, M. (2001). Overview and Summary of Complementary Therapies: Are These Really Nursing Online Journal of Issues in Nursing Vol. 6(2). Retrieved February 26, 2007 from http://www.nursingworld.org/ojin/topic15/tpc15ntr.htm [11] Tomey, A. M., & Alligood, M. R. (1998). Nursing theorists and their work. St. Louis: Mosby [12] Wesley, R. L. (1995). Nursing theories and models. Springhouse, PA: Springhouse Corporation Read More